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Vaccines: Fact and Fiction

When Katie Shutters's 13-month-old daughter, Averie, was born, she followed the recommended vaccine schedule for two months. Then she did some research and decided to hold off on additional shots until Averie turned 9 months old. "I liked the idea of my breast milk giving her the immunities she needs and allowing her body to work for her instead of some medicine," says the stay-at-home mom from Indianapolis. "She isn't in daycare, and we don't travel overseas. I had concerns about injecting her for no reason."

Eventually Shutters found a doctor who would immunize according to her schedule: "We broke up the MMR [which protects against measles, mumps, and rubella] into three separate shots spread out over a year, and we're skipping the chicken pox shot," she says. "Instead, I'd love to find a kid who has chicken pox so we could expose Averie naturally."

If Shutters's approach to vaccination sounds familiar, that's because it is. In fact, most moms don't have to look far beyond their circle of friends to find a family with serious concerns. It's not difficult to understand why. For one, it can be torture to watch your child get jabbed repeatedly with a needle. Combine that discomfort with a steady stream of negative publicity -- celebrity diatribes, alarmist news and Internet reports, ripped-from-the-headline TV shows -- and the wariness seems warranted.

Yet underneath all the debate and impossibly good intentions (after all, everyone hopes to be doing the best for their child no matter how or whether they immunize), there are some solid facts about the benefits of shots that cannot be ignored. "We live thirty years longer now than we did a century ago, thanks to purified water -- and vaccines," says Paul Offit, M.D., chief of infectious diseases at the Children's Hospital of Philadelphia. But as soon as compliance wanes, the protection we have against many devastating, and sometimes fatal, diseases wanes right along with it. This year's measles outbreak -- the biggest in nearly a decade -- may be the first warning shot, says Dr. Offit. Nearly all of the 131 people affected so far, many of them children, were purposely not vaccinated against the disease, according to a new report from the Centers for Disease Control and Prevention (CDC), in Atlanta. "We have to take this seriously," says Anne Schuchat, M.D., director of the CDC National Center for Immunization and Respiratory Diseases. "I do not want to see the day where thousands of kids get this disease and die when we have the tools to prevent it."

So what's a worried mom to do? Between the scary claims about shots themselves and the scary news about what can happen without them, you might feel like you need a Ph.D. in immunology, toxicology, and biostatistics to make sense of it all. The good thing is you don't -- that's what Parenting's here for. We've highlighted four of the concerns we hear regularly and dug through the science to get the facts for you. The bottom line: No medical intervention is 100 percent risk-free, and no one but you can choose what's right for your child. Our job is to help that decision come a little easier, so here goes:

the worry: Vaccines cause autism

what's behind it: This claim first came to the forefront in 1998, after a British study linked the MMR vaccine to 12 children with autism. Prior to this, there had been some concern that thimerosal, a mercury-based preservative common in many vaccines at the time, also may have been partly or totally to blame for some cases of autism.

the facts: So far, ten studies involving thousands of children have failed to find any connection between the MMR and autism. Plus, the original paper suggesting a connec tion between the two was formally retracted by 10 of its 13 authors in 2004. As for the thimerosal issue, there's a bit more backstory worth explaining: First, it's absolutely true that mercury can be harmful. The kind in contaminated fish and water builds up in the body when ingested and can cause severe nerve damage. However, the type of mercury that's in thimerosal doesn't accumulate in the body. "It's never been linked to any adverse effect," says William Schaffner, M.D., professor of preventive medicine at Vanderbilt University Medical Center, in Nashville. Plus, autism rates have continued to rise even after drug companies voluntarily phased out the preservative from all vaccines given to kids (with the exception of some flu shots) in 2001. Clearly, we are far from understanding everything we need to about the range of autistic disorders. And that's why "the possible link between vaccines and autism has been taken very seriously," says Dr. Schuchat. "But at this point, after so many studies, it's safe to say these two hypotheses have been eliminated as possible causes."

the worry: Too many shots too soon is risky

what's behind it: Late last year, the parents of 9-year-old Hannah Poling won a lawsuit in which they claimed that their daughter's autism had been triggered by the five "catch-up" shots for nine diseases she received in one day. She got the injections in 2000, when she was 19 months old. The highly publicized case underscored fears -- also raised by actress Jenny McCarthy, who has a son she believes has recovered from autism -- that the practice of giving multiple vaccines at once is too much for a small child's body to handle.

the facts: Hannah Poling was born with a disorder that affects her mitochondria (the structures within cells that produce energy). And though the family won the settlement on the theory that this underlying vulnerability could have made her more susceptible to vaccine injury, there's actually no proof that she -- or any other child with mitochondrial disease -- was in fact at any increased risk, says neurologist John Shoffner, M.D., associate professor of biology at Georgia State University, in Atlanta, one of the doctors who diagnosed Hannah's disorder. "There is no evidence that the contents of vaccines are the cause of autism or mitochondrial disorders," he says. What's more, because even common illnesses like colds, the flu, and rotavirus can cause significant harm to these children, doctors strongly advise they receive all the recommended shots.

So what does all of this mean for parents of healthy kids? Not much -- getting more than one shot at a time isn't the huge physical stress it seems to be. Their immune systems handle a far greater challenge from everyday exposure to germs on shared toys, doorknobs, and the playroom floor. As Dr. Offit explains it: Think about the bugs that caused your child's last ear infection. Each single bacterium has 2,000 to 3,000 components that stimulate an immune response from the body. As those bacteria multiply, the challenge to the immune system increases exponentially. Your baby feels awful and likely has a high fever and lots of pain. The body pulls out the stops to fight it off. Now compare that to this: "The entire fourteen-shot course of childhood vaccinations contains only about 150 immunological components altogether," says Dr. Offit. This is about a tenth of the challenge posed by exposure to just one microscopic germ. What's more, the bacteria and viruses used in vaccines are either killed or altered, says Martin Myers, M.D., author of Do Vaccines Cause That?! There are just enough to induce immunity, but not enough to make someone sick -- and certainly not enough to overload the immune system of a healthy child. As with any medical intervention, side effects, including soreness, rashes, and fever, are possible, but most are mild and short-lived. In rare instances, some children experience fever-induced seizures following shots, but though these are frightening, they cause no permanent harm.

One common response to these concerns and the autism claims is to break up combination vaccines (which may contain up to five inoculations in one) or to spread them out. But that carries significant risks of its own. "Too often, an immunization delayed is an immunization missed," says Dr. Schaffner. "It's hard enough for parents to keep track." More troubling, during the gaps, kids are susceptible to catching serious diseases they could have been protected from. Vaccines are scheduled when they are for precise reasons: It's a balance between finding the time when the baby's immune system can respond and knowing when he's most in danger of catching the infection, says Dr. Schuchat. Give a shot late and a child is left unprotected at his most vulnerable time. (For help tracking your child's schedule, click here to download a free Vaccine Tracker.)

Robert Sears, M.D., author of The Vaccine Book: Making the Right Decision for Your Child, offers parents an alternative to the American Academy of Pediatrics schedule -- but he does so with Dr. Schuchat's concerns in mind. There are certain vaccines, including those that protect against meningitis, rotavi rus, and pertussis, that he does not recommend delaying for the same reason she gives. However, he willingly offers families the option of postponing hepatitis A and B as well as polio, mainly because these illnesses do not pose the same threat to infants as the others.

the worry: Vaccines contain toxins

what's behind it: Vaccines do contain a variety of substances besides the viral or bacterial components. There are preservatives as well as adjuvants, which are substances that help vaccines grab the attention of the immune system and prompt it to create antibodies. One adjuvant that some are focusing on is aluminum, which at chronic high levels can contribute to nerve, brain, and kidney damage. Because several new vaccines containing aluminum have been added to the schedule, some parents and doctors worry that the extra exposure might push levels out of the safety zone -- particularly given that there's already aluminum pretty much everywhere: in water, breast milk, formula, and the air we breathe. "I'm concerned that health officials haven't done any human-infant research to make sure the amount of aluminum in the vaccines is safe," says Dr. Sears.

the facts: Everyday exposure to aluminum is generally not considered hazardous -- most adults ingest 7 to 9 milligrams (mg) every day through food alone (up to 200 mg if they pop antacids), and formula contains anywhere from .05 mg/L to .93 mg/L. Very little of the aluminum taken in orally is absorbed, and what does make it into the bloodstream is excreted within days. Although the aluminum in vaccines is, of course, injected, there doesn't seem to be evidence it poses any danger for healthy kids. The amount of aluminum injected is no more than .85 mg per dose, and the CDC, the Institute of Medicine, and the World Health Organization have all deemed the levels babies receive from shots to be safe.

However, if you still have concerns, you can ask your doctor to choose low- or no-aluminum vaccines when possible. In the instances when it's not, Dr. Sears will work with aluminum-wary parents by having them bring their babies in once a month between 2 and 7 months of age (rather than bimonthly) so that they get just one aluminum-containing shot at a time. "If doctors don't meet worried parents halfway, the problem of kids not getting vaccinated will continue," says Dr. Sears.

the worry: It's healthier to contract some diseases naturally

what's behind it: The immunity one develops against chicken pox and measles after having the illness is more complete than the protection from the shot. Because that fact is so appealing, chicken pox and measles parties -- where parents intentionally expose a child to the viruses -- have been around for years, and are now on the upswing. Rebecca Foster threw one after her husband, Kevin Burget, came down with shingles, an illness that's caused by the same virus behind chicken pox. The Brooklyn couple had elected not to vaccinate their then 2-year-old son, Hart, against chicken pox (he'd had all his other shots), and they seized the opportunity for the toddler to get it from his dad. The two shared lots of hugs and lots of cups -- and sure enough, Hart picked up the pox. "He hardly itched. It was very mild -- not like the horror stories we'd heard," says Foster. Knowing other parents might want their kids exposed, the couple posted a notice on a local e-mail listserve inviting interested families to come over; two ultimately showed up for a playdate with Hart, during which sharing everything, including lollipops, was encouraged. The visiting kids didn't get sick, but their parents were highly grateful for the chance. "They brought presents," says Foster.

the facts: The potential complications of both chicken pox and measles are far more dangerous than any posed by the shots. "Many young parents think these infections are trivial," Dr. Schaffner says, "which only means they've never seen a child seriously ill with either of them." Consider this: Complications include seizures, pneumonia, or encephalitis (brain inflammation); one or two of every thousand children who come down with measles die or are mentally impaired. In pregnant women, measles can cause miscarriage and premature birth. Chicken pox can lead to staph or strep infections.

Dr. Myers has seen the effects of those infections firsthand. He recalls a 19-month-old whose parents decided he was getting too many shots at once and left off the chicken pox vaccine. "The boy came to our hospital with staph and strep skin infections. It required powerful antibiotics to save him."

To be fair, most kids who get the pox will not end up in the hospital. But, like Dr. Myers's patient, a few will -- and there's a good chance their parents never would have believed it could happen to them. "We'd all love to have absolute truths and guarantees, but that's not always attainable," says Dr. Shoffner. Vaccines are no exception. "We have to make the best decisions we can with the best information available to us."

The cocoon effect

Paige Tomcho was two days past giving birth to her son, Briar, when she started to cough. "I thought it was a cold or allergies," recalls Tomcho, an osteopathic family physician in Waxhaw, North Carolina. A week later, she was still coughing and congested and so was Briar, who developed pneumonia. After he got antibiotics, the baby's lungs cleared up, but he and his mom kept on hacking. Tomcho's cough got so bad that she began throwing up. Soon after, Briar started feeding less, became dehydrated, and his lips turned blue, so Tomcho took him back to the emergency room.

"That's when we learned that we both had whooping cough," she says. Doctors immediately put mom and baby on heavy-duty antibiotics.

Whooping cough, or pertussis, has been making a disturbing comeback over the past two decades, possibly because immunity starts to wane before the teen years. Because of that, in 2006 the CDC began recommending that teens and adults replace their next ten-year tetanus-diphtheria (Td) booster with a tetanus-diphtheria-acellular pertussis (Tdap) booster. Unfortunately, fewer than 2 percent of adults have followed through, and cases have continued to rise.

While pertussis can be miserable for a grown-up, it can be devastating for a baby, says pediatric infectious-disease specialist Mary Healy, M.D., of Texas Children's Hospital, in Houston. About two-thirds of infants under 6 months with pertussis end up in the hospital. "They're more likely to suffer from complications such as pneumonia and brain damage," Dr. Healy says. The long coughing spells can starve the brain of oxygen.

Until their third diphtheria-tetanus-acellular pertussis (DTaP) shot at 6 months, infants are highly susceptible to pertussis, so the best way to keep young babies from getting it is to make sure all family members and caregivers have gotten their boosters and other vaccinations -- a strategy called cocooning.

Cocooning also makes sense when it comes to the flu, another disease that can make babies very sick but which they can't be vaccinated against until 6 months. Influenza is also highly dangerous to pregnant women in the second and third trimesters, which is why the shot is recommended to them when flu season rolls around.

Back in North Carolina, a fully recovered and fully immunized Briar Tomcho has just turned 3. When his baby sister, Tade, was born last summer, Tomcho made sure everyone around her was vaccinated. "Grandparents, friends, aunts, and uncles," she says, "unless they'd had the adult vaccine for pertussis, they did not come into our house! All the children had to be up-to-date as well."

Where to get more info

cispimmunize.org The American Academy of Pediatrics's website provides complete information on vaccines, including answers to safety questions, up-to-date schedules, and vaccine-supply updates.

vaccinateyourbaby.org The website of Every Child By Two, which works to educate and inform parents about vaccines and their history. There's also a cool timeline on the history of vaccinations.

cdc.gov/vaccines The Centers for Disease Control and Prevention's comprehensive site, with all the latest news, downloadable publications, brochures, and statistics.

Jessica Snyder Sachs is the author of Good Germs, Bad Germs, out in paperback this fall.